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An ambulance drives past the emergency entrance of Vancouver General Hospital in April, 2021.JONATHAN HAYWARD/The Canadian Press
Mentally ill people in crisis are frequently discharged from Vancouver’s hospitals before their symptoms are adequately resolved because the limited bed space is needed for a stream of new patients, according to a long-time clinician who oversaw psychiatric care at Vancouver’s downtown hospital.
Bill MacEwan, the former head of psychiatry at St. Paul’s Hospital, said limited space means that health care workers in emergency rooms and psychiatric wards are constantly triaging people with complex mental-health problems.
He said when lots of psychiatric patients arrive at hospital emergency rooms during the same period, ERs struggle to find beds for them while also juggling the admission of other patients who arrive in need of medical attention or even surgery.
“It doesn’t mean that everyone will be inappropriately discharged, but it does create tension and pressure for getting access to beds for people in emerge,” said Dr. MacEwan, who now has multiple jobs providing mental-health care, including treating more than 50 people in supportive housing in suburban Maple Ridge.
His concerns were echoed by a clinician who recently told The Globe and Mail there were missteps in the care given to Kai-Ji Adam Lo, the man charged with 11 counts of second-degree murder for driving his SUV through a crowded Filipino street festival in Vancouver this past spring.
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Premier David Eby attends a candlelight vigil near the scene where a car drove into a crowd of people during the Lapu-Lapu Festival on April 27, 2025, in Vancouver. Kai-Ji Adam Lo was charged with 11 counts of second-degree murder for the attack.Andrew Chin/Getty Images
The clinician, a forensic psychiatrist and a former member of the British Columbia Mental Health Review Board, said the symptoms Mr. Lo was displaying should have been recognized as warning signs, prompting his health care team to forcibly readmit him to hospital.
The Globe is not naming the psychiatrist because they are not authorized to speak to the media. Mental Health Review Board members, who work in panels of three, assess decisions to keep patients detained in hospital against their will.
Mr. Lo, who has also been charged with 31 counts of attempted murder, had been forced into hospital care twice in the previous two years. Each time, he was released under the supervision of a local clinic tasked with enforcing his conditions of “extended leave” meant to improve his long-standing schizophrenia and extensive delusions.
B.C. Premier David Eby has promised to hold a public inquiry into the systemic gaps that led to the attack if these are not identified thoroughly during Mr. Lo’s upcoming criminal trial.
The Vancouver Coastal Health Authority, which runs the region’s hospitals and was in charge of Mr. Lo’s care at the time of his alleged offences, did not comment Friday on whether hospital bed shortages are affecting the quality of mental-health care for the hundreds of its patients on extended leave at any given time.
Lapu-Lapu festival suspect should have been in hospital before attack, experts say
The provincial Ministry of Health issued a statement Friday stating that it is the government’s expectation that health authorities have clear plans to care for patients after they are discharged. The statement said it recognized hospitals are experiencing significant demand and that it continues to improve the system.
“We know there is more to do, and we won’t stop working until people can access the right care to fit their needs, where and when they need it,” the statement said.
The psychiatrist, who does not have direct knowledge of Mr. Lo’s case but was speaking about B.C.’s mental-health care system, said it is the rule – not the exception – that people with psychosis are discharged too quickly.
For patients experiencing psychosis, it typically takes four weeks for hallucinations to dissipate, the psychiatrist explained. For delusions, it takes four months. But in Vancouver, patients with psychosis are generally discharged within a week because of insufficient beds, they added.
The psychiatrist said they routinely direct Vancouver patients an hour south to hospitals in Langley or White Rock, where they are more likely to be detained long enough for their hallucinations and delusions to dissipate.
After The Globe’s reporting on the Lapu-Lapu Day attack last spring, Vancouver Coastal released a statement saying Mr. Lo’s care team had been following him closely, there was no indication he was violent and that “there was no recent change in his condition or non-compliance with his treatment plan that would’ve warranted him needing to be hospitalized involuntarily.”
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But publicly available data back up the psychiatrist’s concerns that B.C.’s mental-health system is overstretched.
There are about 5,915 patients on extended leave in B.C., according to figures released by Health Minister Josie Osborne in the legislature this past summer. That’s just over double the number that were on extended leave in 2020.
More than half of those under extended leave are in the care of the Vancouver Coastal Health authority where Mr. Lo was receiving treatment.
While the pool of patients on extended leave has exploded, the number of those who have been forced to return to hospital after their psychiatrists or social workers recognized they were deteriorating has remained relatively steady in recent years – at roughly 1,350, according to data supplied by the B.C. Ministry of Health this spring.
Other figures tabulated by the Canadian Institute for Health Information show that as of 2023, B.C. had the lowest number of health care professionals per population of any province. The agency said the data on mental-health and substance use workers – ranging from family physicians to social workers, psychiatrists, psychologists, counsellors and other professionals – did not include B.C.’s paramedics that year.
The data show B.C. had 1,319 of these workers per 100,000 of the population in 2023. The national average ratio was 2,023, while Ontario’s ratio was 1,619 and Alberta’s was 1,903.
Dr. MacEwan said the various health authorities need to do a better job prioritizing which patients their small number of staff should focus on.
Vijay Seethapathy, the former chief medical officer at the B.C. Provincial Health Services Authority, said work needs to be done to identify patients on extended leave who have no history of being violent yet may be approaching that point. That way, he argued, they can be better supervised and treated.
Dr. Seethapathy, who until last month was in charge of the umbrella of programs offering voluntary and forced treatment for patients with complex mental-health problems and substance use disorders, said clear markers suggesting a patient could be a danger to themselves or others include repeatedly calling police about delusions of persecution, or visiting the ER on their own accord and then refusing to come back for follow-up treatment.
